health systems, monitoring, evaluation, learning.

Travel

This post has been some time in the making, ever since Raul Pacheco-Vega introduced me to Andrew Szasz’s concept of an ‘inverted quarantine,’ defined further below, and fabulous Manpreet Singh and i started kicking around how the idea applied to our lives in Delhi. This week, a few events, including a desperate effort to stay awake to fend off jetlag, have conspired to help this post come together.

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i’ll start with the idea of a quarantine, since it has such a delightful etymological origin. The phrase comes from the Italian for ’40,’ the number of days a ship needed to stay in the Venetian harbor before its booty or crew came ashore, a practice put in place during the Black Death of the later 1300s. Specifically, the ships subjected to quarantine (or forced isolation) were those returning from plague-stricken countries. The idea, as Szasz elaborates, implies the following set-up: we (Venetians) are mostly in a healthy environment, from which (potentially) diseased individuals need to be kept out. It is a collective (if enforced) action to preserve the health of the environs and, therefore, the people living in it.

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An inverted quarantine is a response to a reversed scenario: an unhealthy environment in which individuals wish to stay healthy. Worse, these individuals have become “fatalistically resigned to it being a dangerous world” (2006). The response is a middle-class or elite response (in general) with two components intended to isolate individuals and their households/immediate environments from harm:

An individual response: Despite ‘the environment’ (air & water, in particular) having a generally public good quality, those constructing inverted quarantines are engaged in a response that “is individualistic in both goal and method.”

A consumeristic response: A sense that the way to isolate oneself and one’s family from harm requires the purchase of specialized commodities, such as bottled water.

It is the latter point, in particular, that converts a citizen (a political actor) into a consumer, who exercises a certain form of exit (to the market) rather than (political/public) voice, thus functioning as a political anesthesia.

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This idea of building bubbles through consumer purchases has many examples in Delhi, with bottled/canister or water filters as a prime example. The air quality in Delhi has recently taken on a similar, if (deplorably) much less wide-spread, response. If you haven’t been paying attention, the air quality in Delhi is real bad (as in, the worst by measures) and air pollution is real bad in general.

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To illustrate, here is a typical workday morning for me in Delhi, which has only been made more extreme by my recent acquisition of an air quality monitor for my house.

Think about how i should buy masks for my mostly faithful autowalla and then wonder if he would use them (curse my non-existant Hindi).

Arrive at office, where air filters are running most of the time, except during skype calls.

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This is not a perfect bubble but it is certainly an attempt at insulating myself nevertheless: an inverted quarantine that i have tried to construct to protect me at home, at work, and in between. i have tried to make myself part of an air-istocracy.

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And, it is worth noting that there is relatively little political action around air quality. The government has experimented with car-reduction measures but, at least anecdotally, folks were far more interested in whether this reduced their commute time than whether it lowered the particulate matter in their air.

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The idea of an inverted quarantine, as presented by Szasz, rests on both the individual and the consumer response. Given both my research and the current outbreaks of dengue and chikungunya and other viral fevers in Delhi, i have been thinking about mosquitoes and whether the concept applies — both whether mosquitoes constitute the sort of unsafe air/water/land of which Szasz writes and also whether the individual/household response is sufficiently consumeristic to count as an inverted quaratine.

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To be glib, we could lump mosquitoes and the diseases they carry in with ‘bad air’ (literally the origin of ‘malaria’) and solve the first problem.

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And the idea of a consumeristic response to mosquitoes may apply to at least some of the options available. Purchasing a bednet allows me to protect my sleeping space from most night-biting mosquitoes, though we have all had the experience that one always manages to get it. Various sprays, creams, bracelets, coils, plug-ins, and electrified tennis racquets can help to ward off mosquitoes but none of them seem to keep all of them away.

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There are also non-consumer responses to limiting mosquitoes and therefore mosquito-borne diseases in the confines of one’s house and grounds, such as covering or draining standing water, as recommended by the government in posters, including this one from my neighborhood:

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It is not quite clear how to classify these individual / private-good responses to larger public health problems that don’t have a strictly product-based bent within a framework of inverted quarantines — but they are certainly an important type of response in India. A similar idea can be found in the constant cleaning of private spaces but the dirtiness of public spaces (as catalogued in Maximum City, inter alia), the intense faith put in ‘home [prepared] food’ as opposed to dirty and dangerous ‘outside food’ and other ideas that mix real ideas of toxins and pathogens with older ideas of purity and pollution (i believe relating to ideas of protecting oneself from social threat, as Szasz discusses).

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In any case, mosquitoes, unlike air quality, are getting political attention in Delhi — or at least, people are calling out the lack of political action and the over-reliance on promoting individual preventative measures in the face of an outbreak. Mosquitoes are annoying little buggers and can (visibly) get through any inverted quarantines we might construct, so perhaps this call for more public, preventative action is not surprising.

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For my thesis research in Ghana, to better understand the context in which a new malaria treatment program was being introduced, i undertook a media content analysis of how the term ‘malaria’ was deployed and discussed in online newspapers during the relevant time period. Most of the discussion was around specific malaria donations that had come in, reporting of malaria numbers at different state health facilities, or actions that the government had or would soon take around malaria prevention and ‘environmental hygiene.’ One of the presidential candidates being covered during that time was particularly concerned about environmental cleanliness and ‘filth.’

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But a few mentions cast malaria as a disease of common humanity, from which neither rich nor poor could make themselves perfectly safe — an actual or imagined inverted quarantine does not exist (especially against day-biting mosquitoes). It (vulnerability to malaria, mosquitoes) was used as a political symbol of issues that affected all Ghanaians. This idea of malaria and the mosquito as threatening a common humanity — the common man — has a slightly funny resonance with the current political situation in Delhi, where the ruling Aam Aadmi Party (literally, ‘the common man party’) has come under fire for insufficient public health action (rightly or wrongly) in the face of an outbreak of mosquito-borne viral fevers.

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The idea of the non-availability of inverted quarantines in the face of the biting mosquito as a source of political action deserves more attention, as does trying to shake people out of believing that their inverted quarantines against polluted air are sufficient (or indeed, that the air is something from which one requires protection) — ideally stimulating meaningful political action. Just thinking about Delhi, i am not yet convinced that measures need to be both individual and consumeristic to act as a political anesthesia. If the goal is to explain a lack of political action, then more conceptual work is needed. For example, as long as my landlords believe their front yard is fresh/unpolluted because they keep a nice garden (and others at their club start to get worried as well), it is unlikely they will be taking any political action about air pollution. Nevertheless, the idea of an inverted quarantine and how it limits public outrage and civic response seems like a useful concept for studying urban (perhaps in particular?) responses to environmental (and pathogen?) threats, not just in the US, where Szasz focuses, but far beyond.

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To close with a small piece from Szasz’s 2006 presentation paper for the Sustainable Consumption and Society Conference:

Inverted quarantine is a twisted and perverse sort of environmentalism. The person who engages in it clearly recognizes that there is a problem [even if misdiagnosed?], is in fact quite distressed by the problem, and intent on doing something about it. Such a person, however, is deeply pessimistic about real change, unable to imagine that things can actually improve, and therefore fatalistically resigned to it being a dangerous world.

Like this:

there has been some complaint from some quarters that i have not recently provided any update about my life, reserving blog posts for slightly more wonky topics.

this post will be a small antidote.*

in delhi, one way of dealing with the energy-sapping heat is nimboo pani — literally “lemons water” but in actuality lemonade that is salty and possibly spicy/masala-ed in addition to sweet. (some people add mint but, of course, such frippery is not welcome in this household. i have only recently found a source for basil leaves, which is a far more sensible option.) in this salty way, nimboo pani approximates ORS and can help combat creeping dehydration, which seems to happen even if you are not noticeably sweating or doing anything at all.

i am curious as to why similarly salty lemonades did not catch-on in other hot places, for example, the southern US, which goes heavy on the sweet drinks in summer but, to my knowledge, doesn’t add salt (granted, the food may provide plenty, so things may balance out).

in any case, to celebrate having my flat nearly in order (yes, i know, people want pictures; patience is a virtue), i had a small open-house party at the beginning of july (HOT). i wanted to have nimboo pani on hand but was uncertain how to have ample drink prepared given the constraints of the refrigerator space and the need to have other drinks and food chilled as well.

one small triumph came in finding a shop that sold pre-squeezed lemon juice. nimboo (lemon) here are generally about golf- ball sized and the prospect of squeezing enough to quench thirst for 5+ hours was unappealing, no matter how many martha stewart points i would earn.

my first thought to dealing with the space issue was to make a lot of nimboo pani in advance and then freeze it. this seemed briefly promising until i thought about using salt to melt ice in the winter. this led to a string of probably unnecessarily dramatic texts to pop of the nature “I HAVE A CHEMISTRY CRISIS.” it was agreed that freezing salty water would be difficult. (it was also likely, tacitly agreed that this was not a crisis.) (follow-up point, auto-correct suggested i might have meant “nimboo panic.” it does fit.)

the ice idea remained promising but how to dissolve all the ingredients on the spot? a friend (thanks, @urmy_shukla!) pointed out that sugar was particularly difficult to mix, given the temperature of the drink. simple syrup presented itself as a solution (ha!). so, in the end, i had frozen lemon cubes and frozen ice tea cubes (in hopes of nimboo pani palmers (go deacs) catching on, but must admit that brown ice has limited appeal, especially in a place where water quality and sanitation are such a serious concerns. perhaps green tea represents a future way forward.) so, people could drop lemon cubes into their glasses of water, which worked out well. i had bowls of rock salt, ground cumin, and ground ginger out so that people could salt and spice their drinks as per their own taste buds. and, i made plain and cardamom simple syrup, which veered slightly towards caramelized but seemed to be ok. this set-up was also good but there is at least one person in our midst who does not agree that drinks should be salty or spicy ever. i may have needed to add a little instruction on how sweet simple syrup is, as @sg402 discovered with VERY sweet nimboo pani.

anyway, party was a success, make-your-own nimboo pani seemed to be a success — so, the world’s problems are nearly solved. basil simple syrup will be pursued in the future.

please do be impressed that i smuggled two public health references into this post.

*a problem with blog-writing is that any word can be a rabbit hole. in typing “antidote,” i wondered if at any time “dote” was used to mean “poison,” in which case, antidote would be a sensible word. “dote” in the sense that we use it now, seems to be derived from the word for foolish. etymology.com implies that dotum comes from the greek “to give,” so that antidote was “to give against.”there you go.

Like this:

whilei have been sick, i have watched/listened to (a fairly absurd amount of) british murder mysteries, including tommy & tuppance and miss marple (including the episode in which miss marple and tuppance team up!).

on another track, there are always funny turns of phrase when working in english in india (and other places). one that always particularly tickled me was referring to “pressurizing” someone to do something, as opposed to “pressing” or “pressuring” someone into something, as i would say. it always seemed like an odd transformation of the word.

but now, thanks to miss marple,i realize that ‘pressurizing’ was in fact a british construction, foisted at some point onto the colonies. i still think it sounds funny but at least i know where to place the blame for a goofy word.

i admit that i am working from an n of 2, purposively selected from Ghana and Nigeria. nevertheless, it seems worth asking, how is national history *not* part of the standard middle or high school curriculum, insofar as knowing history is an important part of educating citizens?

Like this:

that’s the title of a short article in the jan/feb 2013 atlantic— and i couldn’t think of a better one.

i have written previously about the joys of getting and giving directions in lower-income countries – specifically for research and household follow-up, although the general taxi/auto/tuk-tuk stories of trying to reach any specific location purposefully are equally fun (in hindsight).

after reading my initial post, at least one friend reminded me that people at home (in the US) aren’t always so good at directions either, too familiar with a route to think about landmarks or to remember street names, and already too accustomed to google maps & similar being able to get the job done. theatlantic article from the title, about westvirginia, re-emphasizes, for one, that a lack of street names, the use of landmarks, etc, is hardly only a poor-country phenomenon – rather, that “addresses have historically been an urban commodity” and one that probably belonged to highly literate urban areas with people who moved around the city a good deal.

formalizing addresses is more important than the inconvenience of trying to find a location or getting mail delivered. it is also essential for emergency services to find you and is presumably useful for tax collection and other basic services of the state.

which brings us to the second important part of the article: west virgina relied both on 911-services and a deal with verizon to get the mapping and road-naming word underway. knowing the power and visibility of mobile companies in many low- and middle-income countries, would this not be a reasonable way to move the task forward? of all the potential projects for m-dev (e.g. and here, h/t tompaulson), it seems to me that mapping, paying taxes, and vital registration are some of the most promising and fundamental – as well as good public-private ventures. these would be fairly top-down and possibly foucauldian projects, and may be faulted for that, but i think we need more thinking about how the state can connect with its citizens.

finally, the atlanticarticle also points out the fun/difficulty of coming up with that many new street names. on absurd street names presumably combined by some random generator (although the linked article points to a single woman), i think my parent’s town has to take the cake.

drive-by truckers (highway 72):

“Don’t know why they even bother putting this highway on the mapEverybody that’s ever been on it knows exactly where they’re at.”